Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children and adolescents. ADHD is often chronic with prominent symptoms and impairment spanning into adulthood. ADHD is often associated with co-occurring disorders including disruptive, mood, anxiety, and substance abuse. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry and neuropsychological data. Consideration of all aspects of an individual s life needs to be considered in the diagnosis and treatment of ADHD. 

Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for ADHD and comorbid problems. Pharmacotherapy including stimulants, noradrenergic agents, alpha agonists, and antidepressants plays a fundamental role in the long-term management of ADHD across the lifespan. 

The management of ADHD includes consideration of two major areas: non-pharmacological (educational remediation, individual and family psychotherapy) and pharmacotherapy. 

I personally support Psychotherapy. Specialized educational planning based on the child s difficulties is necessary in a majority of cases. Since learning disorders co-occur in one-third of ADHD youth, ADHD individuals should be screened and appropriate individualised educational plans developed. Educational adjustments should be considered in individuals with ADHD with difficulties in behavioral or academic performance. Increased structure, predictable routine, learning aids, resource room time, and checked homework are among typical educational considerations in these individuals. Similar modifications in the home environment should be undertaken to optimize the ability to complete homework. For youth, frequent parental communication with the school about the child s progress is essential. 

Symptoms in children and teenagers 

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six. They occur in more than one situation, such as at home and at school. The main signs of each behavioural problem are detailed below:

Inattentiveness: having a short attention span and being easily distracted making careless mistakes   for example, in schoolwork appearing forgetful or losing things being unable to stick at tasks that are tedious or time-consuming appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks 
Hyperactivity and impulsiveness: being unable to sit still, especially in calm or quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger 
These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline. 

Related conditions in children and teenagers 

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as: 

anxiety disorder   which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness 
oppositional defiant disorder (ODD)   this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers 
conduct disorder   this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals 
depression 
sleep problems   finding it difficult to get to sleep at night, and having irregular sleeping patterns 
autistic spectrum disorder (ASD)   this affects social interaction, communication, interests and behaviour 
epilepsy   a condition that affects the brain and causes repeated fits or seizures 
Tourette s syndrome   a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics 
learning difficulties   such as dyslexia Symptoms in adults In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD. 
ADHD is a developmental disorder; it's believed that it can't develop in adults without it first appearing during childhood. But it's known that symptoms of ADHD often persist from childhood into a person's teenage years, and then adulthood. Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood. By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives. The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD. But some specialists say that the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms. 

Some specialists have suggested the following list of symptoms associated with ADHD in adults: 

carelessness and lack of attention to detail 
continually starting new tasks before finishing old ones 
poor organisational skills 
inability to focus or prioritise 
continually losing or misplacing things 
forgetfulness 
restlessness and edginess 
difficulty keeping quiet and speaking out of turn 
blurting out responses and often interrupting others 
mood swings, irritability and a quick temper 
inability to deal with stress 
extreme impatience 
taking risks in activities, often with little or no regard for personal safety or the safety of others   for example, driving dangerously 
Additional problems in adults with ADHD As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: 

personality disorders   conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others 
bipolar disorder   a condition that affects your moods, which can swing from one extreme to another 
obsessive-compulsive disorder (OCD)   a condition that causes obsessive thoughts and compulsive behaviour 
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job. If you notice any of the above in your child or yourself , it is worth making the effort and spending some time and money to have your child and or yourself assessed on a priority basis as ADHD causes neural changes in the brain. 

Attention Deficit Hyperactivity Disorder (ADHD) - A Guide!

While children can light up your life with joy and laughter, sometimes they can appear to be monsters with their temper tantrums and their stubbornness. Stubborn or obstinate children can be very difficult to deal with and could end up disrupting your life as well. However, there are a few techniques that mental health professionals have suggested that can help you deal with your stubborn and obstinate child. These are mentioned here briefly  

Hear Them Out: It s often the case that children tend to be stubborn or obstinate and start screaming when they think they weren t heard. This makes them feel helpless and thus forces them to bottle up and then take out their frustration by either not doing what you are telling them to do or doing exactly the opposite of that. The best treatment in this scenario is to hear them out and patiently try to resolve their problems.

Ensure They Follow Your Example: If one or both of the parents are extremely stubborn, then this would translate into a stubborn kid as well. Doctors have said that obstinacy is often in the genes. Also, environmental influence is a big deal for them as well. Ensure that you are flexible enough with your partner and the child picks up on it.

Teaching Kids About Give And Take: This is a very important lesson in life as it teaches kids to choose priorities. If you teach your kid to always give, then it sends a message that putting themselves second is the best option. However, if he or she is always fighting to take first priority, it may lead to too many conflicts later. Thus it is best to teach them that it is okay to fight for what is yours but also let others have their way sometimes. This attitude will help them develop a balanced attitude and lessen their obstinacy.

Give Them The Illusion Of Choice: Children are very malleable when it comes to their minds and you can use this trick to do certain things that make them appear they have some control when they actually may not. For example, if they are unwilling to go to sleep, you can say that you cannot make them sleep, but they have to stay in bed. Your child would then automatically fall asleep after some time due to boredom which would end up serving your purpose.

Use Scolding Or The Parent Card As A Last Resort: If any of the techniques mentioned don t work, then you can scold or warn your kid with consequences which may result in capitulation. For example, if you child is not willing to come back and study, then try and stop them from whatever they were doing and make them sit with their books. This lets them know that certain areas you will absolutely not compromise on and they will understand the limits better.

How To Deal With Stubborn Or Obstinate Children?

Children generally tend to be fairly over active and have lesser attention spans. However, when this tends to get into their performance at school and in general with getting along with other children it may be a sign of ADD or attention deficit disorder. Let's look at some of the common symptoms of this disorder.

Symptoms of ADD

1. Problems in staying focused: One of the very basic symptom is that children will often be very inattentive even during classes and will be easily distracted by small things.

2. Problems in trying to remember things or difficulty in following instructions: Children with attention deficit disorder tend to have issues with remembering things and if given tasks, being unable to complete as they can't remember instructions properly.

3. Issues with organizing, planning and trying to finish tasks: Due to the lack of attention, kids have problems retaining information and cannot plan or finish tasks given to them on a daily basis.

4. Easily bored or loses interest: Even if a child with ADD starts with something they like, interest may wane off quickly. Thus it is difficult to make them stick to a specific work schedule which may require regular practice.

5. Lack of attention to details and making careless mistakes: This is another trait of children with attention deficit disorder. They may be able to complete a task, but it will be fraught with mistakes as they wouldn't have much attention to detail.

6. Has a tendency to not listen when someone is speaking to them: This is also very common and is usually tied to being easily distracted and thus will drift off or not listen to when someone is speaking to them.

Some Myths about ADD

a. All kids with ADD are hyperactive
b. They will eventually grow out of it
c. Medication is the only option to treat ADD
d. ADD is not really a disorder and kids need to be trained better

Most of these are half truths and the extent of the problems varies from child to child. Only proper counseling will be able to diagnose the extent of the problem and what needs to be done.

How to spot ADD in Children

ADD can be spotted in children aged below 7 years via certain symptoms. Apart from the ones mentioned above, children generally tend be abrasive towards others and can make embarrassing comments quite often. They also change tasks very quickly without completing any of them. Any distraction would force them to change their track. It is best to go to a child specialist to get your child checked out for possible symptoms.

Symptoms and Myths About Attention Deficit Disorder (ADD) and How to Spot Them in Children

Cystic Fibrosis is a genetic disorder that is known to affect some of the vital organs of the body including the lungs, digestive system to name a few. For long it was believed that cystic fibrosis affects a person in their childhood. However, various research and studies suggest that adults are also susceptible to this inheritable disorder. In this article, we will discuss the cause and symptoms associated with cystic fibrosis.

Cause
The epithelial cells that line the stomach, nasal cavity and lungs, are responsible for the production of the digestive fluids, sweat, tears, mucus. The Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene codes for a protein called the CFTR protein. The CFTR protein, a membrane protein plays a pivotal role in transporting the chloride ions of the epithelial cells inside and out of the cell. This regulation of the chloride ions goes a long way in ensuring that the mucus produced is free-flowing and thin.

In the case of Cystic Fibrosis, the CFTR gene that codes for the protein undergoes a mutation. With the CFTR protein unable to perform its function, sticky and thick mucus builds up and clogs some of the major systems of the body including the digestive system, reproductive, and respiratory system. There is also a higher salt content in the sweat of the affected person.

For a person to be affected by cystic fibrosis, he/she must inherit a copy of the mutated CFTR gene from both the parents ( Autosomal Recessive Disorder) at birth.

Symptoms
The symptoms associated with cystic fibrosis depends on the organs and systems affected.

The thick mucus formed can clog the digestive tract resulting in incomplete absorption of the essential nutrients from the food. This may have an impact on the overall growth and development of the body.
- There may be stunted growth or no weight gain.
- The stool may appear greasy and foul smelling. Some may also suffer from constipation.
- Newborns and infants may suffer from an intestinal blockage.
Cystic fibrosis, left unattended can lead to diabetes, intestinal blockage or obstruction.
- The mucus can also block the bile duct triggering a host of problems including liver disorders.
- At times, the obstruction or blockage can occur at the junction where the large and the small intestine meets (Distal intestinal obstruction syndrome).
The thick mucus can also affect the lungs and the respiratory system by blocking the tubes that act as a passage carrying the air inside and out of the lungs. As a result,
- A person may suffer from lung infections frequently.
- There may be difficulty in breathing, stuffy and blocked nose, or wheezing.
- Some people may also suffer from a chronic cough with a thick sputum.
Left untreated the complications can worsen resulting in

Nasal polyps, Chronic infections, Hemoptysis (there is blood while coughing), and Pneumothorax (air fills up in the space bifurcates the chest wall from the lungs).

In severe cases, there may be a respiratory failure.

Cystic fibrosis can also trigger fertility problems (both in males and females).

Cystic Fibrosis- Causes and Symptoms!

Insulin is the most common treatment prescribed for people affected with diabetes. Diabetes is condition where high amounts of glucose prevail in the blood for an extended period of time. However, there are some drugs that offer an alternative to insulin in treating diabetes, which are:

1. Liraglutide: Liraglutide is a glucagon-like peptide-1 (GLP-1) drug that causes the body to release greater amounts of insulin so as to facilitate the movement of glucose from the blood to the cells. People with type 2 diabetes generally use this treatment. It slows the digestion process and can cause symptoms of headache and nausea. 

2. Pramlintide: It's an artificially produced version of amylin. It is taken by both type 1 and type 2 diabetic patients, facilitates slower digestion of food and therefore, controls release of sugar in the blood. It can cause tiredness and nausea.

3. Dulaglutide:This treatment is for people affected with type 2 diabetes and it is administered once a week. It causes more insulin to be released and pass the glucose to the cells. It can cause loss of appetite, nausea and abdominal cramps as side effects.

4. Albiglutide: This treatment facilitates pancreas to release insulin and limits the glucagon hormone production. It is used by type 2 diabetes patients who have not taken well to other treatments. The side effects are skin reaction, respiratory tract infection and nausea.

5. Exenatide: It is a drug that causes pancreas to release insulin that facilitates movement of glucose to cells. It is a treatment for type 2 diabetes and it restricts release of glucagon in the body. The possible side effects are acidity, constipation and vomiting.

Common Insulin Alternatives

A genetic disorder, Down s Syndrome is caused due to extra genetic material during cell division. It is the faulty arrangement of chromosomes which results in the Down s Syndrome. It approximately affects one in 800 births around the world, across a wide spectrum of race, gender, region, and socio-economy. Since it is a naturally occurring condition whose underlying cause cannot be controlled or regulated, there is nothing one can do to undo this condition. Instead, people with Down s Syndrome, because they are generally socially and intellectually underdeveloped, are equipped with learnings and interventions related to life-skills from very early in life and striving towards making them independent. Various therapies can be incorporated for improving the overall quality of life of the people born with Down s Syndrome.

Occupational Therapy and Down s Syndrome -

Development of motor skills is delayed in the children born with Down s Syndrome. This is due to their certain physical characteristics like low muscle tone (hypotonia), loose ligaments or ligamentous laxity making the joints extra flexible, and decreased strength.

The aim of the Occupational Therapy for children born with Down s Syndrome is to facilitate or enable the development of movement patterns optimally, as against accelerating the rate of development which is a general assumption. It helps in achieving developmental milestones in an efficient manner. Occupational Therapy hence helps children in developing a good or correct posture, aligning their foot properly for proper balance and movement, improving their walking pattern, and helping them generally through developing fine and gross motor skills for carrying out daily activities.

Moreover, Occupational Therapy helps in teaching self-care skills like getting dressed, eating, toileting writing, using a computer, etc. For teenagers, Occupational Therapy helps in identifying suitable skills, careers, jobs, and vocations to match with strengths, capabilities, and interests. Sensory integration activities help in teaching the child to produce an appropriate response to any situation, and in developing attention and concentration.

Occupational Therapy Assessment -

Children with Down s Syndrome have delayed gross and fine motor skills, and lack basic cognitive and communication skills among many other issues they face due to their condition. Occupational Therapy addresses all these shortcomings of development for comprehensive management of the disease.

Occupational Therapy checks the sensorimotor components like muscular tone, strength, endurance, coordination, balance, range of motion, hand function, and posture. It also checks the perceptual and cognitive components like memory, attention, figure-ground, and directionality. For checking social skills, areas like peer relationship, verbal and non- verbal communication, and group interaction are assessed.

According to the assessment results, intervention strategies and fun activities are devised for the child to promote optimal function of motor senses.

Take Away -

Down s Syndrome cannot be cured but can be managed through methods like Occupational Therapy which helps in teaching basic life skills for making the patients confident and independent to face the world on their own.

Down Syndrome - Know How Occupational Therapy Can Help!

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